What is a meniscus root tear, and why is it treated differently?

Where the root is and what it does

Each meniscus is a C-shaped cushion with two ends, called roots, that are fixed firmly into the top of the shin bone. When you stand or walk, the meniscus is squeezed outward, and the roots hold it in place like the two ends of a rope. This tension, called hoop stress, is what lets the meniscus spread body weight across the cartilage.

If a root tears or pulls away from bone, the rope is cut. The meniscus may still look present on a scan, but it no longer works as a shock absorber.

Why surgeons take root tears seriously

Laboratory and clinical studies show that a complete root tear raises the pressure on the cartilage to a level similar to having the meniscus removed. Over months, the meniscus often drifts outward, which surgeons call extrusion, and the unprotected cartilage can wear faster.

In some patients, the bone beneath the cartilage becomes overloaded and develops a small stress fracture, known as a subchondral insufficiency fracture. This can cause a sudden increase in pain and swelling.

The two main types

• Posterior medial root tears: the most common type, usually in adults from middle age, often after a minor movement such as squatting or stepping down
• Lateral root tears: more common in younger, active people, and frequently found together with an ACL tear after a twisting sports injury

What happens next

Treatment depends on your age, the condition of the cartilage, leg alignment and how the knee is affecting you. In a knee with healthy or mildly worn cartilage, repairing the root back to bone is often recommended. When arthritis is already advanced, non-surgical care or other operations may suit better.

Dr. Gelber reviews the MRI, standing X-rays and examination together at Aman Hospital in Doha before advising on a plan.